scholarly journals Pathways to Care

2019 ◽  
pp. 439-466
Author(s):  
Ramin Mojtabai ◽  
Sarah Murray ◽  
William W. Eaton
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Mental Health Treatment ◽  
Insurance Coverage ◽  
Theoretical Models ◽  
Health Insurance Coverage ◽  
Treatment Seeking ◽  
Pathways To Care ◽  
Mental Health Treatments

This chapter discusses the gap between the need for mental health care and the actual receipt of such care, and the barriers that contribute to this gap. These barriers include attitudes such as stigma, negative attitudes about the benefits of mental health treatments, and lack of perceived need for care. Another set of barriers is related to the structure of services such as scarcity of providers, geographical distance, and inadequate health insurance coverage of mental health services. The chapter describes theoretical models used to understand the process of treatment-seeking and examples of initiatives that have been used to overcome barriers to care. Among these initiatives, public campaigns aimed at increasing awareness and recognition of mental disorders and at reducing stigma, and legislative initiatives aimed at increasing insurance coverage for mental health care have received public attention. Future initiatives to improve access to services and reduce the treatment gap would benefit from a better understanding of the process of treatment-seeking and barriers to mental health treatment.

scholarly journals Chronic Illness and Internalizing Symptomatology in a Transdiagnostic Clinical Sample of Youth

2020 ◽  
Vol 45 (6) ◽  
pp. 633-642
Author(s):  
Elizabeth R Wolock ◽  
Alexander H Queen ◽  
Gabriela M Rodríguez ◽  
John R Weisz
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Depressive Symptoms ◽  
Mental Health Care ◽  
Mental Health Treatment ◽  
Physical Illness ◽  
Treatment Needs ◽  
Health Treatment ◽  
Chronic Physical Illness ◽  
Internalizing Symptomatology

Abstract Objective In research with community samples, children with chronic physical illnesses have shown elevated anxiety and depressive symptoms, compared to healthy peers. Less is known about whether physical illnesses are associated with elevated internalizing symptoms even among children referred for mental health treatment—a pattern that would indicate distinctive treatment needs among physically ill children receiving mental health care. We investigated the relationship between chronic physical illness and internalizing symptomatology among children enrolling in outpatient mental health treatment. Method A total of 262 treatment-seeking children ages 7–15 and their caregivers completed a demographic questionnaire, Child Behavior Checklist, and Youth Self-Report during a pre-treatment assessment. Physical illnesses were identified through caregiver report. Results There was no overall association between the presence/absence of chronic physical illness and parent- or child-reported symptoms. However, number of chronic physical illnesses was related to parent- and child-reported affective symptoms. Children with two or more chronic physical illnesses had more severe depressive symptoms than those with fewer physical illnesses. Conclusion Having multiple chronic illnesses may elevate children’s risk of depression symptomatology, even in comparison to other children seeking mental health care. This suggests a need to identify factors that may exacerbate depression symptoms in physically ill children who are initiating therapy and to determine whether different or more intensive services may be helpful for this group. The findings suggest the potential utility of screening for depression in youth with chronic physical illnesses, as well as addressing mental and physical health concerns during treatment.

scholarly journals Mental Health and Service Use of Migrants in Contact with the Public Psychiatry System in Paris

2020 ◽  
Vol 17 (24) ◽  
pp. 9397
Author(s):  
Andrea Tortelli ◽  
Florence Perquier ◽  
Maria Melchior ◽  
François Lair ◽  
Fabien Encatassamy ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Asylum Seekers ◽  
Service Use ◽  
Pathways To Care ◽  
Treatment Level ◽  
Stable Housing ◽  
Increased Risk ◽  
Provision Of Care

Background: Migrants, and particularly asylum seekers, are at increased risk of psychiatric disorders in comparison with natives. At the same time, inequalities in access to mental health care are observed. Methods: In order to evaluate whether the Parisian public psychiatric system is optimally structured to meet the needs of this population, we examined data on mental health and service use considering three different levels: the global system treatment level, a psychiatric reception center, and mobile teams specializing in access to psychiatric care for asylum seekers. Results: We found higher treatment rates among migrants than among natives (p < 0.001) but inequalities in pathways to care: more mandatory admissions (OR = 1.36, 95% CI: 1.02–1.80) and fewer specialized consultations (OR = 0.56, 95% CI: 0.38–0.81). We observed a mismatch between increased need and provision of care among migrants without stable housing or seeking asylum. Conclusions: Inequalities in the provision of care for migrants are observed in the Parisian public psychiatric system, particularly for those experiencing poor social and economic conditions. There is a need to facilitate access to mental health care and develop more tailored interventions to reduce discontinuity of care.

scholarly journals Adult experts’ perceptions of telemental health for youth: A Delphi study

JAMIA Open ◽  
2018 ◽  
Vol 1 (1) ◽  
pp. 67-74 ◽  
Author(s):  
Abigail Howard ◽  
Mindy Flanagan ◽  
Michelle Drouin ◽  
Maria Carpenter ◽  
Elizabeth M Chen ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Lived Experience ◽  
Delphi Study ◽  
Instant Messaging ◽  
Youth Mental Health ◽  
Pathways To Care ◽  
Telemental Health ◽  
Knowledge Barriers

Abstract Objectives Our objectives were to measure experts’ opinions and develop consensus via the Delphi process on the barriers, applications, and concerns associated with telemental health (TMH) for youth. Materials and methods We delivered 3 online surveys over 2 months in Summer, 2016–2025 adult experts, including adults who experienced youth depression or suicidality, parents of youth with lived experience, and professionals (ie youth mental health researchers, clinicians/staff, or educators). We used the Delphi method to construct Likert and open-ended questions, developing expert consensus over 3 iterative surveys on the barriers and benefits of TMH for youth. Results Adult experts identified stigma and knowledge barriers to youth mental health care. Although TMH is perceived as beneficial for screening, education, follow-up, and emotional support, no single delivery method (eg websites or instant messaging) was deemed universally beneficial. Discussion Adults are the developers, administrators, and gatekeepers of youth mental health care. Although adult experts see potential for TMH to supplement traditional therapy via familiar technologies, there is no consensus on the technologies by which TMH should be delivered. However, there is consensus that family members and friends provide potential pathways to care; thus, an online TMH toolkit for youth would be beneficial for both caretakers and practitioners. Conclusion Telemental health may not overcome barriers for crisis management but adult experts agreed that TMH had potential benefits for youth. Health care organizations should conduct research and provide training and education to youth caretakers and practitioners on potential barriers and benefits of TMH technologies for youth.

scholarly journals Reform of psychiatric services in Germany: hospital staffing directive and commissioning of community care

2004 ◽  
Vol 28 (6) ◽  
pp. 218-221 ◽  
Author(s):  
Heinrich Kunze ◽  
Thomas Becker ◽  
Stefan Priebe
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Social Services ◽  
Access To Health Care ◽  
Insurance Coverage ◽  
Legal Framework ◽  
Free Access ◽  
The Government ◽  
The Uk

The German mental health care system differs significantly from the system in the UK. There is no central organisation with overall responsibility as in the National Health Service (NHS), and the government is not entitled to prescribe details of policy or set specific targets. It can only determine the legal framework, define general goals and, with difficulties, influence the spending level. Responsibilities for mental health care, as for other fields of health care, are shared between federal authorities, the 16 states (Lander), local authorities, and semi-statutory organisations, which govern out-patient health care provided by psychiatrists in office-based practices. Virtually every citizen is health-insured and there is free access to health care for those who have no insurance coverage, in which case social services usually cover the costs. Social services also directly fund various services in the community. The fragmented system can be difficult to comprehend. However, many of the challenges are similar to those in other countries, and policy makers and practitioners elsewhere might be interested to know some of the lessons learnt in the German system.

scholarly journals THE CULTIVATING SEEDS SYSTEM™ (CSS™): A POTENTIAL FRAMEWORK TO INCREASE MENTAL HEALTH RESOURCES

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Yvonne Larrier ◽  
Monica D. Allen ◽  
Irwin M.H. Larrier
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Health Care Professionals ◽  
Mental Health Treatment ◽  
Global Mental Health ◽  
Health Resources ◽  
Mental Health Research ◽  
Middle Income ◽  
Treatment Research

Global mental health research is continuing to unearth the multiple systemic barriers that over 80% of the world’s population experiences in their search for cultural, contextual, and efficient mental health treatment and services. The widespread gaps and shortages in treatment, research, interventions, financial resources, and mental health care specialists are enduring and expansive thus leaving behind many communities and societies in low and middle income countries and high income countries. Whereas there are numerous approaches to these gaps, this article proposes a re-conceptualized approach to the promotion, practice, and intervention of mental health services locally and globally, with the Cultivating SEEDS System (CSS™) framework. This framework addresses two of the most prevalent barriers – the stigma associated with accessing mental health care resources, and the lack of mental health care professionals.

scholarly journals Pathways to mental health care in Nepal: a 14-center nationwide study

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Anoop Krishna Gupta ◽  
Sulochana Joshi ◽  
Bikram Kafle ◽  
Ranjan Thapa ◽  
Manisha Chapagai ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Mental Health Professionals ◽  
Clinical Presentation ◽  
Service Providers ◽  
Mental Illnesses ◽  
World Health ◽  
Pathways To Care ◽  
Duration Of Untreated Illness

Abstract Background Pathways to care studies are feasible and tested means of finding the actual routes taken by patients before reaching proper care. In view of the predominance of nonprofessional service providers and the lack of previous large studies on pathways in Nepal, this multicenter study is needed. The aim of the study was to trace the various pathways and carers involved in mental health care; assess clinical variables such as the duration of untreated illness, clinical presentation and treatment; and compare geographically and culturally diverse landscapes. Methods This was a cross-sectional, convenience sampling study performed at 14 centers where new cases were being taken. The World Health Organization Study of the Pathways-to-Care Schedule was applied. The Nepali version of the encounter form was used. The data were collected between 17 September and 16 October 2020 and were analyzed using the Statistical Package for the Social Sciences (SPSS). Additionally, perspectives from local investigators were collected and discussed. Results Most of the first carers were native/religious faith healers (28.2%), followed by psychiatrists (26%). The median duration for the first psychiatric consultation was 3 weeks. The duration of untreated illness was 30.72 ± 80.34 (median: 4) weeks, and the time taken for this journey was 94.99 ± 274.58 (median: 30) min. The longest delay from the onset of illness to psychiatric care was for epilepsy {90.0 ± 199.0 (median: 25.5)} weeks, followed by neurotic illness {22.89 ± 73.45 (median: 2)} and psychotic illness {10.54 ± 18.28 (median: 2)} weeks. Overall, most patients with severe mental illnesses (SMIs) had their first contact with faithhealers (49%), then met with medical doctors (13%) or psychiatrists (28%). Marked differences in clinical presentation surfaced when hilly centers were compared with the Terai belt. Conclusions Faith healers, general practitioners and hospital doctors are major carers, and the means of educating them for proper referral can be considered. The investigators see several hindrances and opportunities in the studied pathways. The employment of more mental health professionals and better mental health advocacy, public awareness programs and school education are suggested strategies to improve proper mental health care.

scholarly journals Veterans� Attitudes Toward Smartphone App Use for Mental Health Care: Qualitative Study of Rurality and Age Differences (Preprint)

2018 ◽  
Author(s):  
Samantha L Connolly ◽  
Christopher J Miller ◽  
Christopher J Koenig ◽  
Kara A Zamora ◽  
Patricia B Wright ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Access To Care ◽  
Mental Health Treatment ◽  
Urban Areas ◽  
Qualitative Interviews ◽  
Adjunctive Treatment ◽  
Smartphone Apps ◽  
Rural And Urban

BACKGROUND Mental health smartphone apps provide support, skills, and symptom tracking on demand and come at minimal to no additional cost to patients. Although the Department of Veterans Affairs has established itself as a national leader in the creation of mental health apps, veterans’ attitudes regarding the use of these innovations are largely unknown, particularly among rural and aging populations who may benefit from increased access to care. OBJECTIVE The objective of our study was to examine veterans’ attitudes toward smartphone apps and to assess whether openness toward this technology varies by age or rurality. METHODS We conducted semistructured qualitative interviews with 66 veterans from rural and urban areas in Maine, Arkansas, and California. Eligible veterans aged 18 to 70 years had screened positive for postraumatic stress disorder (PTSD), alcohol use disorder, or major depressive disorder, but a history of mental health service utilization was not required. Interviews were digitally recorded, professionally transcribed, and coded by a research team using an established codebook. We then conducted a thematic analysis of segments pertaining to smartphone use, informed by existing theories of technology adoption. RESULTS Interviews revealed a marked division regarding openness to mental health smartphone apps, such that veterans either expressed strongly positive or negative views about their usage, with few participants sharing ambivalent or neutral opinions. Differences emerged between rural and urban veterans’ attitudes, with rural veterans tending to oppose app usage, describe smartphones as hard to navigate, and cite barriers such as financial limitations and connectivity issues, more so than urban populations. Moreover, rural veterans more often described smartphones as being opposed to their values. Differences did not emerge between younger and older (≥50) veterans regarding beliefs that apps could be effective or compatible with their culture and identity. However, compared with younger veterans, older veterans more often reported not owning a smartphone and described this technology as being difficult to use. CONCLUSIONS Openness toward the use of smartphone apps in mental health treatment may vary based on rurality, and further exploration of the barriers cited by rural veterans is needed to improve access to care. In addition, findings indicate that older patients may be more open to integrating technology into their mental health care than providers might assume, although such patients may have more trouble navigating these devices and may benefit from simplified app designs or smartphone training. Given the strong opinions expressed either for or against smartphone apps, our findings suggest that apps may not be an ideal adjunctive treatment for all patients, but it is important to identify those who are open to and may greatly benefit from this technology.

Depression, anxiety, and patterns of mental health care among men with prostate cancer on androgen deprivation therapy (ADT).

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 12100-12100
Author(s):  
Phoebe A. Tsao ◽  
Ryan Ross ◽  
Amy S. B. Bohnert ◽  
Bhramar Mukherjee ◽  
Megan Veresh Caram
Keyword(s):  
Mental Health ◽  
Prostate Cancer ◽  
Health Care ◽  
Mental Health Care ◽  
Reuptake Inhibitor ◽  
Increased Risk ◽  
Norepinephrine Reuptake Inhibitor ◽  
Mental Health Treatments ◽  
New Diagnosis ◽  
Insured Patients

12100 Background: ADT is associated with an increased risk of depression and anxiety, raising the concern that a substantial portion of men with prostate cancer need mental health care. We sought to investigate the development of depression or anxiety and subsequent patterns of mental health care in men with prostate cancer on ADT. Methods: Clinformatics DataMart, a claims database of commercially insured patients, was used to identify men with prostate cancer who received ADT between 2001-2015 and had continuous enrollment for 1 year before and 2 years after starting ADT. We determined the rate of incident diagnoses of depression or anxiety and the incident use of mental health treatments - psychotherapy and psychiatric medications (≥ 5 day supply) - after the start of ADT. Results: Among 37,388 men in the final analytic cohort, 11.3% (n=4239, 95% confidence interval (CI) 11.0-11.6%) received new diagnoses of depression or anxiety: 5.8% depression (95% CI, 5.5-6.0%), 3.7% anxiety (95% CI 3.5-3.9%), and 1.8% both (95% CI, 1.7-1.9%). Those who received a diagnosis of depression or anxiety were more likely to be white (68% v. 64%, p<0.01); no differences were noted in age, education, or household income. Among those with a new diagnosis of depression or anxiety, 0.07% received psychotherapy (95% CI, 0.02-0.23%), 34.9% a selective serotonin reuptake inhibitor (95% CI, 33.5-36.4%), 11.6% a serotonin norepinephrine reuptake inhibitor (95% CI, 10.7-12.6%), and 19.9% a benzodiazepine (95% CI, 18.7-21.1%). Conclusions: Among men with prostate cancer receiving ADT, more than 1 in 10 received a new diagnosis of depression or anxiety. Of those, 1 in 5 were introduced to a benzodiazepine, a drug class with risks of dependence, cognitive impairment, falls, and fractures, whereas receipt of psychotherapy was rare. Further investigation into how to improve the mental health care of men on ADT is needed. [Table: see text]

scholarly journals Seeking Psychosocial Care After Interpersonal Violence: An Integrative Model

2009 ◽  
Vol 24 (3) ◽  
pp. 322-336 ◽  
Author(s):  
Viola Schreiber ◽  
Babette Renneberg ◽  
Andreas Maercker
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Interpersonal Violence ◽  
Help Seeking ◽  
Traumatic Event ◽  
Psychosocial Care ◽  
Theoretical Models ◽  
Integrative Model ◽  
The Individual

Many people experience a traumatic event at least once in their lifetime. But only a fraction of those traumatized and in need of mental health care receive psychosocial care or treatment. This may be due to barriers people experience within the help-seeking process. The individual help-seeking process is consequently highly relevant for any mental health care for trauma survivors. Understanding why people refrain from asking for help or delay the help-seeking process is central to understanding help-seeking after traumatization. Based on empirical data and theoretical models, an integrative model of individual mental health help-seeking is developed. This integrative model delineates parameters relevant for seeking psychosocial care or refraining from it.

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